Are nicotine replacement products safe for pregnant women?

There’s no question that pregnant women who smoke are putting their unborn babies in danger. The negative consequences associated with smoking during pregnancy include ectopic pregnancy, problems with the placenta, preterm delivery, and low-birth-weight babies, to name a few. Newborn death rates from sudden infant death syndrome (SIDS) and preterm deliveries are higher among fetuses exposed to their mothers’ smoke.

Quitting before pregnancy is the goal for a healthy baby. But for those mothers who haven’t or can’t quit cold turkey, is nicotine replacement therapy a safe option?

The answer is unclear. The research on whether nicotine replacement aids for smoking cessation hasn’t confirmed whether these products—including gums, inhalers, lozenges, nasal sprays, and skin patches—are safe or effective for pregnant women. However it is likely that nicotine therapy is less hazardous than cigarette smoking, which exposes both the mother and fetus to nicotine and many other toxicants.

In 2000, government guidelines on smoking cessation stated nicotine replacement therapy was safe for all adults except pregnant women and people with heart or circulatory disease. While later guidelines relaxed the recommendation to include people with heart and circulatory disease, there still isn’t enough evidence to be absolutely sure that nicotine replacement therapy is safe for use in pregnant women.

There is, however, some evidence to suggest nicotine replacement therapy might be safer for the baby than smoking. Research on the topic includes a 2012 paper analyzing six studies conducted on a total of 1,745 pregnant women on nicotine replacement therapy. Results of the review showed pregnant women on nicotine replacement therapy were no more likely than pregnant women not on the therapy to suffer miscarriages, premature births, or to have low birth-weight babies or newborns that had to be admitted to an intensive care unit.

Still other research suggests that pregnant women’s use of nicotine replacement patches might elevate fetal heart rates. And some studies have linked nicotine replacement products to low birth weight.

Pregnant moms who can’t quit should talk with their doctors or healthcare providers about smoking cessation and programs that can help with quitting. Even quitting early in a pregnancy reduces smoking-related risks to the baby. Many doctors will recommend that pregnant moms try other approaches to quitting before turning to nicotine replacement therapy, simply because nicotine alone is unhealthy for the fetus. Women who are on nicotine replacement therapy during pregnancy should be under the close supervision of their doctors.

Reviewed by Dr. Jen Lincoln, April 2020